风湿病学组织建议手术前是否需要停用巴瑞替尼片?何时停用和重新启用? |
本文旨在提供关于风湿病学组织建议手术前是否需要停用巴瑞替尼片的相关信息,仅供医疗卫生专业人士参考。 |
回复:
尚未在围手术期对巴瑞替尼的使用进行系统研究,但 RA 指南建议在手术前 3-4 天停用 JAK 抑制剂,并根据伤口愈合情况在约 14 天内重新开始使用。
感染风险与免疫抑制治疗
免疫抑制治疗,包括用于治疗类风湿关节炎(RA)的疗法,可能增加围手术期感染和伤口愈合延迟的风险。1
决定何时暂停 RA 的免疫抑制治疗及暂停多长时间时,需要平衡炎性疾病复发风险和感染风险。1-3
风湿病学组织的围手术期建议
各风湿病学组织提供的围手术期建议各不相同,但从过往来看主要集中在传统和生物制剂改善病情抗风湿药(DMARD)的使用方面。1,3-5 最近的指南包括了对 Janus 激酶( JAK)抑制剂在内的新型药物的基本建议。6-8
美国风湿病学会和美国髋膝外科医师协会
美国风湿病学会(ACR)和美国髋膝外科医师协会(AAHKS)发布的一组专门针对择期全髋关节置换术(THA)或全膝关节置换术(TKA)手术的风湿性疾病患者的指南。6
2017 年 ACR/AAHKS 指南涉及到广泛的抗风湿治疗药物,包括 DMARD 糖皮质激素和 JAK 抑制剂托法替布。6
加拿大风湿病学协会和英国风湿病学会
2018 年英国风湿病学会发布更新指南,建议根据药物给药间隔时间和各种生物疗法药代动力学半衰期确定手术时间。11
参考文献
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2Härle P, Straub RH, Fleck M. Perioperative management of immunosuppression in rheumatic diseases—what to do? Rheumatol Int. 2010;30(8):999-1004. http://dx.doi.org/10.1007/s00296-009-1323-7
3Bombardier C, Hazlewood GS, Akhavan P, et al. Canadian Rheumatology Association recommendations for the pharmacological management of rheumatoid arthritis with traditional and biologic disease-modifying antirheumatic drugs: part II safety. J Rheumatol. 2012;39(8):1583-1602. http://dx.doi.org/10.3899/jrheum.120165
4Ledingham J, Deighton C; British Society for Rheumatology Standards, Guidelines and Audit Working Group. Update on the British Society for Rheumatology guidelines for prescribing TNFalpha blockers in adults with rheumatoid arthritis (update of previous guidelines of April 2001). Rheumatology (Oxford). 2005;44(2):157-163. http://dx.doi.org/10.1093/rheumatology/keh464
5Ledingham J, Gullick N, Irving K, et al. BSR and BHPR Standards, Guidelines and Audit Working Group. BSR and BHPR guideline for the prescription and monitoring of non-biologic disease-modifying anti-rheumatic drugs. Rheumatology (Oxford). 2017;56(6):865-868. https://doi.org/10.1093/rheumatology/kew479
6Goodman SM, Springer B, Guyatt G, et al. 2017 American College of Rheumatology/American Association of Hip and Knee Surgeons guideline for the perioperative management of antirheumatic medication in patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty. Arthritis Care Res (Hoboken). 2017;69(8):1111-1124. http://dx.doi.org/10.1002/acr.23274
72022 American college of rheumatology/American association of hip and knee surgeons guideline for the perioperative management of antirheumatic medication in patients with rheumatic diseases undergoing elective or total hip or total knee arthroplasty. Guideline summary. Updated March 17, 2022. Accessed June 2, 2022. https://www.rheumatology.org/Portals/0/Files/Perioperative-Management-Guideline-Summary.pdf
8Albrecht K, Poddubnyy D, Leipe J, et al. Perioperative handling of the therapy of patients with inflammatory rheumatic diseases: Updated recommendations of the German Society of Rheumatology. J Rheumatol. 2022;81:212-224. https://doi.org/10.1007/s00393-021-01140-x
9Fleisher LA, Beckman JA, Brown KA, et al. 2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2009;54(22):e13-e118. https://doi.org/10.1016/j.jacc.2009.07.010
10Falck-Ytter Y, Francis CW, Johanson NA, et al. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed. American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 suppl):e278S-e325S. https://doi.org/10.1378/chest.11-2404
11Holroyd CR, Seth R, Bukhari M, et al. The British Society for Rheumatology biologic DMARD safety guidelines in inflammatory arthritis-Executive summary. Rheumatology (Oxford). 2019;58(2):220-226. https://doi.org/10.1093/rheumatology/key207
12The German Society of Rheumatology (DGRh): monitoring sheets for therapies approved in Germany. January 2021. Accessed June 2, 2022. https://dgrh.de/dam/jcr:468986c8-6516-4b39-9aaf-4d9d6fdf30e2/Baricitinib_Arzt_01_21.pdf